Improving Clinical Encounter Communications to Enhance Minority Diabetes Care

医疗保健提供和结果方面的差异在一定程度上与医生在治疗中遇到的困难有关 与种族、民族和性别不同的患者建立有效的沟通 经济环境。糖尿病和糖尿病前期营养性肥胖是 指向。种族和社会经济差异可能会阻碍医生理解患者的 限制现实，例如日常活动中涉及的复杂权衡和决策策略，如 购买食物和药物。当关于糖尿病诊断和治疗的临床接触不是 根据患者的实际情况量身定做，它们不太可能导致对什么是共同的理解 必须这么做。反过来，这可能会导致医生认为少数族裔患者不遵守规定，并 无视他们的建议。为了有效，这些基于相遇的关于护理、行为和自我护理的讨论 要求对话适应文化假设、认知/情感关切和系统性社会-- 病人个体的经济限制。这方面需要改进--临床医生治疗 受健康差距影响的人群必须具备理解如何制定和实施 根据这些患者的独特需求定制他们的对话。我们设想的系统--实现增强型患者 通过援助和培训相遇(重复)-将提供当前(非常)的创新替代方案 最低限度)培训。它将最佳实践封装在低成本、无处不在的可访问系统中，基于 体验式学习。Repeat将提供一个逼真的虚拟环境，允许通过 与合成标准化患者(SSP)的模拟交互。这些都是交互式计算机生成的 可以对临床医生的行为(语言和非语言)做出真实行为和反应的化身。新兴认知 模拟技术将向SSP灌输属性(例如，环境和经济限制， 信念、态度、恐惧)，代表特定患者亚群的共同特征。 第一阶段将构建一个初步的重复原型，作为与SSP的一组有限的虚拟临床会面 以智能家教技术中的学习脚手架为支撑。这些虚拟会面将 允许临床医生练习与SSP交互，并从SSP的交互中学习 关注人群--经济不景气城市中的糖尿病前期和糖尿病非裔美国患者 食物沙漠。此第一阶段原型将在我们的医疗保健部门进行学习效果和用户接受度评估 合作伙伴，弗吉尼亚联邦大学医学院，使用临床医生样本(n=20)。这 这项工作将对如何开发有效的SSP并将其嵌入到可行的 训练环境。这项技术有可能被广泛使用，包括一个版本 可供患者使用，并通过改善提供者和 病人。它还具体解决了医科学生、住院医生和 具有文化敏感度、人际交往能力和沟通能力的医生。

Disparities in healthcare delivery and outcomes have been linked, in part, to the difficulties physicians have in establishing effective communication with patients who differ from themselves in terms of race, ethnicity and economic circumstances. Diabetes mellitus and pre-diabetic nutrition-based obesity are an important case in point. Racial and socio-economic differences can impede doctors' ability to understand their patients' constraining realities, such as the complex tradeoffs and decision strategies involved in daily activities like purchasing food and medications. When clinical encounters about diabetes diagnosis and management are not tailored to the patient's pragmatic realities, they become less likely to lead to a shared understanding of what needs to be done. This can, in turn, lead physicians to perceive that minority patients are non-compliant and ignoring their advice. To be effective, these encounter-based discussions about care, behavior, and self-care require a dialog that is adaptive to the cultural assumptions, cognitive/emotional concerns, and systemic socio- economic constraints of the individual patient. This area is in need of improvement - clinicians treating populations affected by health disparities must possess the competencies to understand how to frame and tailor their dialogs to the unique needs of these patients. The system we envision-Realizing Enhanced Patient Encounters through Aiding and Training (REPEAT) - will provide an innovative alternative to current (very minimal) training. It encapsulates best practices in a low cost, ubiquitously accessible system based on experiential learning. REPEAT will offer a realistic virtual environment that allows learning to occur through simulated interactions with synthetic standardized patients (SSPs). These are interactive computer-generated avatars that can act and react realistically to clinician (verbal and via nonverbal) behaviors. Emerging cognitive simulation technology will imbue the SSPs with attributes (e.g., environmental and economic limitations, beliefs, attitudes, fears) that are representative of shared characteristics of a specific patient subpopulation. Phase I will build a preliminary REPEAT prototype as a limited set of virtual clinical encounters with SSPs supported by learning scaffolding drawn from intelligent tutoring technology. These virtual encounters will allow clinicians to practice interacting with, and to learn from interactions with, SSPs that represent an initial population of concern - pre-diabetic and diabetic African-American patients in economically depressed urban food deserts. This Phase I prototype will be assessed for learning effect and user acceptance at our healthcare partner, the Virginia Commonwealth University School of Medicine, using a sample of clinicians (n=20). This work will provide considerable insight into how to develop effective SSPs and embed them into a viable training environment. The technology has the potential to be translated to broad usage, including a version usable by patients, and to reduce healthcare disparities by improving communication among providers and patients. It also specifically addresses broader mandated requirements for medical students, residents and physicians in Cultural sensitivity, and Interpersonal Skills and Communication.